On The Job Injury Reporting

If a UVM employee has a work-related injury or illness (a
condition that develops over time, such as carpal tunnel syndrome
or tendinitis), he/she must fill out an Employer's First
Report of Injury form. Both the
Worker's responsibilities and the Supervisor's responsibilities
are listed below.

WORKER'S RESPONSIBILITIES

1. NOTIFY YOUR SUPERVISOR as soon as possible
and assist him or her in completing an Employer's First Report of
Injury. Send the completed form to Risk Management. Risk Management
must send the Report to the Department of Labor and Industry within
72 hours of the date of injury, subject to penalty for
non-compliance.

2. TELL YOUR DOCTOR THAT YOU WERE INJURED ON THE
JOB. Medical bills should be sent to Risk Management
for payment under worker's compensation (not your health insurance
plan). Receipts for out of pocket expense, such as prescription
medication and equipment, should be sent to Risk Management for
reimbursement under worker's compensation.

3. IF YOU ARE UNABLE TO WORK AS A RESULT OF YOUR
INJURY, NOTIFY YOUR SUPERVISOR. Keep your supervisor
informed of your progress and anticipated return to work date. You
must provide your supervisor and Risk Management with a doctor's
note which authorizes your absence from work.

4. IF YOU ARE ABLE TO WORK PART TIME OR CAN WORK
WITH TEMPORARY JOB MODIFICATION please notify your
supervisor and Risk Management. A Temporary Modified Duty Work
Agreement must be completed. This agreement specifies your
doctor's restrictions and temporary work assignment as well as the
time period your doctor recommends the restrictions should remain
in place.

5. ADDITIONAL FORMS AND CONTACT WITH THE INSURANCE
ADJUSTOR may be necessary. Your claim is subject to
investigation by the University's insurance adjustor. Complete all
requested forms and return them to Risk Management as quickly as
possible.

SUPERVISOR'S RESPONSIBILITIES

1. COMPLETE THE EMPLOYER'S FIRST
REPORT OF INJURY AND SEND IT TO RISK
MANAGEMENT AS SOON AS POSSIBLE. Risk Management must
send the form to Labor and Industry within 72 hours of the report
of injury. As the supervisor, YOU are the employer. The employee
has the responsibility to report the injury or illness and assist
the supervisor in completing the Employer's First Report of
Injury. If the employee is unable to assist you, complete the form
to the best of your ability. An employee has six months from the
time an injury is known to be work related to report it, one year
for an illness (such as carpal tunnel syndrome).

2. COMMUNICATE WITH RISK MANAGEMENT. Call
the
claims specialist if your employee is unable to work, or when they
return to work, following a work related injury or illness. If you
have information relative to the investigation of a worker's
compensation claim, notify the claims specialist.

3. COMMUNICATE WITH YOUR EMPLOYEE. Ask
how they are doing, when they expect to come back to work, and
keep them involved with what's happening at work. Statistics
indicate this contact with the work place can assist the employee
in recovering from an injury or illness.

4. CONSIDER PROVIDING TEMPORARY MODIFIED DUTY
WHICH WILL ALLOW YOUR EMPLOYEE TO RETURN TO WORK.
Often, an employee who is unable to perform their usual work tasks
can work in some capacity. View the necessary work tasks with a
creative eye, or identify special projects the employee may be
able to work on. Consider allowing your employee to return to work
on a part time basis.